Fire fighters suffer more line of duty injuries than any occupation in the United States and line of duty fatality rates are only surpassed by miners and agricultural workers (1). Emphasis on reducing fire fighter injuries and fatalities has concentrated on improvements in personal protective equipment (PPE) to prevent exposures (heat, smoke, and toxins). The benefit of improved PPE on reducing smoke inhalation and burn injuries is undeniable and long overdue. However, despite improvements, line of duty injuries and fatalities have remained remarkably constant over the last 5 or more years (1,3-6). A secondary event resulting from improved PPE, has been that fire fighters can now operate at the fire scene for longer, uninterrupted time periods. Fire fighting requires fire fighters to work at near maximal exertion; exhaustion is the rule; over exhaustion occurs and becomes more common with longer, uninterrupted work time at the fire scene. Over exhaustion is clearly a major risk factor for injuries and fatalities. We are unaware of any fire department, including the NYC Fire Department (FDNY), which monitors and controls the time that fire fighters work uninterrupted at a fire scene. Primarily, this is because prior to improved PPE, the fire itself served as a natural control. Heat, noxious fumes and smoke prevented fire fighters from penetrating too deep or working too long at the fire scene. Now that this has changed, we believe that fire fighting Standard Operating Procedures (SOPs) must change to include time control as a primary factor if we are to ensure fire fighter safety and reduce injuries.